Education, enforcement, treatment

LIHU‘E — Almost a year ago, a bold crime in broad daylight left

a young man dead and another man facing the possibility of spending

the rest of his life behind bars. The fuel for the murder:

oxycodone.

Editor’s note: This is the final installment in a series on prescription drugs. Visit www.thegardenisland.com to view previous parts.

LIHU‘E — Almost a year ago, a bold crime in broad daylight left a young man dead and another man facing the possibility of spending the rest of his life behind bars. The fuel for the murder: oxycodone.

Island lawmakers say painkillers are a necessity but also a danger to the community, and that something needs to be done to address a growing abuse among residents of all ages.

“This problem is just as serious as our cocaine and meth problems,” said state Rep. Derek Kawakami, D-14th District.

The only difference, he said, is that because painkillers are available at pharmacies and prescribed by a doctor, “kids and young adults may have a false sense of security.”

Oxycodone, used to relieve moderate to severe pain, is in a class of medications called opiate (narcotic) analgesics, according to the U. S. National Library of Medicine. Oxycodone is sold under brand names Oxycontin and Roxicodone and is available as generic alternatives. It also used to be marketed under six other brand names no longer available.

“It works by changing the way the brain and nervous system respond to pain,” the library’s website states. Oxycodone is also available in combination with acetaminophen (Endocet, Percocet, Roxicet, Tylox), aspirin (Endodan, Percodan, Roxiprin) and ibuprofen (Combunox).

The library lists 29 side effects, 14 of them serious enough to call a doctor immediately. Giving away or selling the drug to others is illegal and may cause death.

The U.S. National Library of Medicine — a federal government branch that claims to be the world’s largest medical library — hardly touches on the drug’s highly addictive tentacles. It does state that “oxycodone can be habit-forming” and warns people if they stop taking the medication suddenly they may experience withdrawal symptoms.

More than regulation, the main problem Kawakami sees with painkillers is the drug ending up in the wrong hands, especially those of children and young adults.

“Whether they are raiding someone else’s medicine cabinet or finding them on the streets, they are ending up in the hands of people who are misusing drugs,” he said. “People are taking them for recreational use, and what may start out as fun and games will many times spiral out of control.”

Regulations

Kaua‘i County Councilman KipuKai Kuali‘i said the regulation of prescription painkillers is almost non-existent.

“If you have a license to practice medicine in Hawai‘i and you prescribe a reasonable amount of painkillers for a particular ailment, say 30 to 50 pills of Oxycontin (5 to 10 mg) no one will question it,” he said.

Law enforcement officers have said the only way they can take action is if prescribers step outside medical procedures, according to Kuali‘i.

Kaua‘i County Councilman Mel Rapozo, a former Kaua‘i Police Department sergeant, said he is working on proposed amendments to state laws related to prescription drugs. As the president of the Hawai‘i State Association of Counties, he said he would be proposing changes because he believes the law needs tightening.

Painkillers’ strong addictive properties and limited treatment programs add up to a growing problem, he said. Prescription drug abuse, a “terrible problem” nationwide, is getting worse due to availability becoming easier, he added.

Kuali‘i said pain clinics generally don’t conduct medical examinations; their entire business seems to center on diagnoses from other doctors.

One pain clinic on Kaua‘i, he said as an example, has two requirements: that a patient is at least 18 years old and has medical records. Doctors who “freely write” prescriptions for no medical reasons are getting away with it, he added.

“There needs to be strict oversight on doctors and pain clinics who prescribe pills for a profit,” Kuali‘i said.

There should be a  way to make the healthcare and prescription drug industries non-profit rather than for-profit, he said, or capping the profits from such companies.

In 2010, the federal government passed the Secure and Responsible Drug Disposal Act, which allows authorized personnel to collect and dispose prescription drugs on behalf of consumers, according to U.S. Rep. Mazie Hirono, D-Hawai‘i.

This law reduces the amount of unused and expired medications out in the community and ensures drugs are disposed of in an environmentally friendly way, she said.

In recent years, there have been several bills targeting the abuse of specific types of prescription medications that have not become law, Hirono said.

“I am concerned about the illegal use of the specific drugs named in those bills,” she said. “But I would prefer to see more comprehensive legislation that addresses the wide range of medications that are being abused and provides educational and outreach programs for those who need them.”

Kawakami, who joined this year’s state Legislature mid-session after serving on the council, said there were several measures addressing regulation of painkillers and related matters introduced this year.

“Of these measures, one bill was enacted into law, Act 73, regarding reporting requirements in conformance to federal drug laws and two measures were adopted as resolutions (HC R055 and SCR 025) to request the Hawai‘i State Board of Nursing develop a pain and palliative care program for chronic pain sufferers,” he said.

Five of those bills that didn’t pass this year will likely carry over the 2012 Legislature, Kawakami said. Those bills include measures seeking authorization for psychologists to prescribe certain therapeutic drugs, redefining naturopathic drugs and allowing naturopathic physicians to prescribe controlled substances, and requirements for insurers to provide coverage for physical therapy to treat chronic pain.

Solutions

The best way to stop the abuse of prescription drugs is to attack the underlying causes, Hirono said.

“Whether it’s due to mental health issues, post-traumatic stress syndrome, or socio-economic factors, it is critical to address these issues at the source,” she said. “We also need to support effective treatment programs that enable drug users to beat their addictions.”

Kawakami said he believes it will take a concerted effort — with collaboration from all stakeholders involved — to address the problem.

“Painkillers have become the drug of choice for many kids today,” Rapozo said. “We have to address this immediately.”

But to rely on federal laws regulating prescription and medication alone is a “virtually impossible” task, Hirono said.

“Instead, we need to use a variety of tactics to combat what is one of our nation’s fastest-growing drug problems,” she said.

President Barack Obama’s National Drug Control Strategy includes a comprehensive policy to fight prescription drug abuse, the Congresswoman said.

“We must educate the medical community, patients, and parents about prescription drug abuse while also implementing prescription drug monitoring programs in all 50 states,” she said.

“We must also empower law enforcement to combat prescription drug abuse, such as curbing the reported practices of ‘doctor shopping’ and visiting ‘pill mills.’”

The attitude toward prescription medications have changed dramatically in the last decade, Hirono said. The public needs to be better educated about the serious dangers associated with prescription drugs, especially painkillers, she added.

“In cases where people have already become addicted to prescription drugs, we need to support effective treatment programs that enable them to overcome their addiction,” Hirono said.

Despite a somber outlook, Kuali‘i said it is possible to prevent abuse — all it takes is everyone working together.

“We can continue to do enforcement and prosecution to a certain extent, but we need to do more prevention,” said Kuali‘i, citing education as key in prevention efforts, along with community participation. “We definitely also need more education for pharmacists, physicians and the general public.”

Ultimately, the biggest difference is through education, treatment, rehabilitation and after-care programs, he said, adding that reducing demand is also important for success. 

“In the end, it’s not about enforcement or making more laws,” Kuali‘i said. “It’s about people and giving them all the reasons to make good decisions about their own and their community’s health and welfare.”

• Léo Azambuja, staff writer, can be reached at 245-3681 (ext. 252) or lazambuja@ thegardenisland.com.

Brand names

Oxycontin

Roxicodone

Dazidox*

Endocodone*

ETH-Oxydose*

Oxyfast*

OxyIR*

Percolone*

Brand names of combination products

Combunox (containing ibuprofen, oxycodone)

Endocet (containing acetaminophen, oxycodone)

Endodan (containing aspirin, oxycodone)

Oxecta (containing acetaminophen, oxycodone)

Percocet (containing acetaminophen, oxycodone)

Primlev (containing acetaminophen, oxycodone)

Roxicet (containing acetaminophen, oxycodone)

Percodan (containing aspirin, oxycodone)

Tylox (containing acetaminophen, oxycodone)

Xolox (containing acetaminophen, oxycodone)

Magnacet (containing acetaminophen, oxycodone)

Lynox* (containing acetaminophen, oxycodone)

Narvox* (containing acetaminophen, oxycodone)

Perloxx* (containing acetaminophen, oxycodone)

Roxiprin* (containing aspirin, oxycodone)

Taxadone* (containing acetaminophen, oxycodone)

*These branded products are no longer on the market, only genericalternatives are available.

Last revised Oct. 15 by the U.S. National Library of Medicine,National Institute of Health.

HB 484

Requires hospitals to allow advanced practice registered nursesto practice within the full scope of allowable practice, includingas a primary care provider. Authorizes advanced practice registerednurses with prescriptive authority to request, receive, anddispense samples of over the counter and non-controlled legenddrugs.

The measure was passed by the Legislature and signed into lawJune 14 as Act 110 by Gov. Neil Abercrombie.

HB 1085, SB 1305

The measure amends chapter 329, Hawai‘i Revised Statutes, tobring Hawai‘i statutes on controlled substances to be consistentwith the federal laws on controlled substances, and increases thefee for the registration certificate for qualifying patients formedical marijuana.

The measure stopped at the Senate, but went all the way throughat the House.

The measure was passed by the Legislature and signed into lawJune 1 as Act 73 by Gov. Neil Abercrombie, becoming effectiveimmediately.

HB 1217, SB 1359

Defines “dangerous drugs” in the penal code to includemephedrone and methylenedioxypyrovalerone, also known as MDPV.

Senate bill didn’t move. House recommended the measure bedeferred.

SB 1052

Proposed housekeeping amendments to the offense of promotingdangerous drugs in the third degree.

No movement.

HB 35

Requires a prescription to purchase any product containingpseudoephedrine.

No movement.

SB 702

Directs the attorney general to coordinate a review of theimpact of diverting marijuana and low-level felony drug offendersout of the criminal justice system and into treatment.

No movement.

HB 1146, SB 659

Authorizes a naturopathic physician to prescribe controlledsubstances.

No movement in the House. Senate recommended deferral.

HB 1169

Clarifies the state’s medical use of marijuana law. Increasespenalties for fraudulent application to make consistent withpenalties for other controlled substances.

No movement.

SB 174

Removes marijuana and tetrahydrocannabinols from the schedule Icontrolled substances list and places them in the schedule IIIcontrolled substances list.

Passed second reading, referred to Judiciary and LaborCommittee, where it stopped.

HB 142, SB 252

Directs the Attorney General to coordinate a review of theimpact of diverting marijuana and felony drug offenders out of thecriminal justice system into treatment.

House recommended deferral. Senate recommended measure beheld.

Source: Lawmakers, www.capitol.hawaii.gov.